Organization
EASTMAN DRUG COMPANY INC
Active
Other names
EASTMAN DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
IRVIN CHRISTENSEN (PRESIDENT)
(208) 547-3585
Entity
Organization
Contact information
Practice address
116 S MAIN ST, SODA SPRINGS, ID 83276-1428
(208) 547-3585
(208) 547-3585
Mailing address
116 S MAIN ST, SODA SPRINGS, ID 83276-1428
(208) 547-3585
(208) 547-3585
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1045RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001035100
—
ID
01
—
2020327
PK
—
Enumeration date
07/30/2006
Last updated
04/21/2017
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